Treatment of PTLD with rituximab or chemotherapy
Treatment of PTLD with rituximab or chemotherapy
复制标题
DOI：
10.1111/j.1600-6143.2005.01211.x
复制
发表时间：
2006-03-01
影响因子：
8.8
通讯作者：
Tsai, DE
中科院分区：
文献类型：
--
作者：
Elstrom, RL;Andreadis, C;Tsai, DE
除了减少免疫抑制（RI）外，关于移植后淋巴组织增生性疾病（PTLD）治疗的信息有限。我们回顾性评估了接受利妥昔单抗和/或化疗治疗PTLD的患者的反应，治疗失败时间（TTF）和总生存期（OS）。35例患者符合入选标准。22例患者接受利妥昔单抗治疗，总缓解率（ORR）为68%。19个月时未达到中位TTF，估计OS为31个月。在单变量分析中，EB病毒（EBV）阳性预测反应和TTF。LDH升高预测OS较短。没有患者死于利妥昔单抗毒性，所有进展的患者均接受进一步化疗治疗。23例患者接受化疗。ORR为74%，中位TTF为10.5个月，估计OS为42个月。影响疗效的预后因素包括肿瘤分期、LDH和同种异体移植物受累。这些因素和缺乏完全缓解（CR）预测生存率低。接受化疗的患者中有26%死于毒性。利妥昔单抗和化疗是有效的PTLD患者谁失败或不耐受RI。虽然利妥昔单抗耐受性良好，但化疗的毒性明显。需要RI以上治疗的PTLD患者应考虑使用利妥昔单抗，尤其是EBV阳性疾病。化疗应保留给利妥昔单抗治疗失败、EBV阴性肿瘤或需要快速反应的患者。
Information regarding treatment of post-transplant lymphoproliferative disease (PTLD) beyond reduction in immunosuppression (RI) is limited. We retrospectively evaluated patients receiving rituximab and/or chemotherapy for PTLD for response, time to treatment failure (TTF) and overall survival (OS). Thirty-five patients met inclusion criteria. Twenty-two underwent rituximab treatment, with overall response rate (ORR) 68%. Median TTF was not reached at 19 months and estimated OS was 31 months. In univariable analysis, Epstein-Barr virus (EBV) positivity predicted response and TTF. LDH elevation predicted shorter OS. No patient died of rituximab toxicity and all patients who progressed underwent further treatment with chemotherapy. Twenty-three patients received chemotherapy. ORR was 74%, median TTF was 10.5 months and estimated OS was 42 months. Prognostic factors for response included stage, LDH and allograft involvement by tumor. These factors and lack of complete response (CR) predicted poor survival. Twenty-six percent of the patients receiving chemotherapy died of toxicity. Rituximab and chemotherapy are effective in patients with PTLD who fail or do not tolerate RI. While rituximab is well tolerated, toxicity of chemotherapy is marked. PTLD patients requiring therapy beyond RI should be considered for rituximab, especially with EBV-positive disease. Chemotherapy should be reserved for patients who fail rituximab, have EBV-negative tumors or need a rapid response.